Corporate Headquarters
139 Mill Rock Road East
Old Saybrook, CT 06475
800-966-0664

Donation

Three Easy Ways to Donate:

Complete form below and submit online (* is required)
Print and mail to:
Vehicle Donation Processing Center
139 Mill Rock Road East
Old Saybrook, CT 06475
Fax to 860-388-4477 or call 800-966-0664 and we can process your donation over the phone.

Charity Name*

Name* Street*

City* State* Zip*

Best/Day time Phone* Cell Email

Vehicle Make* Model* Year*

Color* Mileage*

Vehicle ID # (VIN)*

Location of vehicle if different from above

Is the title free and clear of lien? Yes No

Can vehicle be driven 20 miles? Yes No If car cannot be driven 20 miles, state the reason:

Vehicle must be accessible by flatbed tow truck (i.e. driveway)?

Check off areas of damage

Right Front	Left Front	Hood
Right Rear	Left Rear	Trunk
Right Side	Left Side	Roof

Note: The vehicle MUST have a title, no liens, and four inflated tires and have a complete engine to be accepted into our program. Please remove license plates and all personal items from vehicle before scheduled pick-up date and place the title and keys in the glove box. Donor signs name on seller location on back of title and charity name is listed as buyer.

How did you hear about our program?

Radio	Please specify:	Friend/Relative	Please specify:
Mailing	Kind:	Newspaper	Which one?
Emissions Station	Please specify:	Billboard	Location?
2nd Time Donor	Please specify:	Other	Please specify:

Comments:
	Thank You For Your Donation